Bloody Stool in Infants: A Pediatric Allergy View

Yıl 2023, Cilt: 17 Sayı: 4, 304 - 308, 25.07.2023

Gizem Atakul , Seda Şirin , Özge Atay , Özge Kangallı Boyacıoğlu , Serdar Al , Suna Asilsoy , Nevin Uzuner , Özkan Karaman

https://doi.org/10.12956/tchd.1198501

Öz

Objective: The prevalence of food allergy (FA) has gradually increased. Bloody stool is among the symptoms associated with non-immunoglobulin E (IgE) mediated FA in infants. In our study, we shared the clinical characteristics of the patients who applied to our clinic with bloody stool.

Material and Methods: The data of the patients with bloody stool were reviewed. Patients’ characteristics and the time of onset of tolerance in patients with FA were recorded, retrospectively.

Results: The 110 patient files were reviewed. 68% of the patients were diagnosed with FA (63 proctocolitis/12 enterocolitis), 22% with an anal fissure, and 9% with nonspecific colitis. The most common causative food was cow milk (57%), the second was the combination of egg and milk (24.2%), and the third was egg (18.2%). The presence of atopic dermatitis (AD) and eosinophil count at the time of admission did not affect tolerance development time but it was shown that skin prick test (SPT) positivity and the high level of total IgE at the time of admission delayed the development of tolerance [(p=0.02), (r=0.510, p=0.009)].

Conclusion: Bloody stool is one of the common complaints in infants. It does not always indicate a FA. The clinic is mild when the underlying disease is non-IgE mediated FA. However, accompanying IgE-type sensitivities negatively affect the prognosis. Elevated total IgE and SPT positivity at the time of diagnosis may give an impression that tolerance of baked products could be delayed in this type of allergy.

Anahtar Kelimeler

Atopic dermatitis, Food allergy, Gastrointestinal hemorrhage, Infant, Proctocilitis

İnfantlarda Kanlı Gayta: Pediatrik Alerji Bakışı

Öz

Amaç: Besin alerjisi (BA) sıklığı giderek artan bir hastalıktır. Kanlı gayta yakınması infantlarda non immunoglobulin E (IgE) aracılı BA ile ilişkilendirilen semptomlar arasındadır. Çalışmamızda kanlı gaita nedeniyle kliniğimize başvuran hastaların klinik özellikleri paylaşılmıştır.

Gereç ve Yöntemler: Kanlı gaitası olan hastaların verileri incelendi. Hastaların özellikleri ve BA saptanan hastalarda toleransın ne zaman geliştiği restrospektif kaydedildi.

Bulgular: 110 hastanın kayıtları incelendi. Bunlardan %68’i BA (63 proktokolit/12 enterokolit), %22’si anal fissür, %9’u nonspesifik kolit tanısı aldı. Şüpheli besin olarak en sık inek sütü (%57), ikinci sıklıkta yumurta ve süt birlikteliği (%24.2), üçüncü sıklıkta yumurta (%18.2) saptandı. Atopik dermatit (AD) olması, başvuru anındaki eozinofil sayısı tolerans zamanını etkilemezken deri prick test (DPT) pozitifliği ve başvuru anındaki yüksek total IgE düzeyinin toleransı geciktirdiği bulundu [(p=0.020), (r=0.510, p=0.009)].

Sonuç: Kanlı gaita, infantil dönemde sık karşılaşılan şikayetlerden biridir. Her zaman besin alerjisine işaret etmez. Altta yatan hastalık non-IgE kaynaklı BA olduğunda klinik ılımlıdır .Ancak eşlik eden IgE tipi duyarlılıklar prognozu olumsuz etkiler. Tanı anındaki total IgE yüksekliği ve DPT pozitifliği bu tip alerjilerde fırınlanmış ürün toleransının geç olacağı yönünde fikir verebilir.

Anahtar Kelimeler

Atopik dermatit, Besin alerjisi, Gastrointestinal hemoraji, İnfant, Proktokolit

Kaynakça

• Labrosse R, Graham F, Caubet JC. Non-IgE-Mediated Gastrointestinal Food Allergies in Children: An Update. Nutrients 2020;12:2086.
• Cianferoni A. Non-IgE Mediated Food Allergy. Curr Pediatr Rev 2020;16:95-105.
• Meyer R, Chebar Lozinsky A, Fleischer DM, Vieira MC, Du Toit G, Vandenplas Y, et al. Diagnosis and management of Non-IgE gastrointestinal allergies in breastfed infants-An EAACI Position Paper. Allergy 2020;75:14-32.
• Osman D, Djibré M, Da Silva D, Goulenok C. Management by the intensivist of gastrointestinal bleeding in adults and children. Ann Intensive Care 2012;2:46.
• Romano C, Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG, et al. Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology. World J Gastroenterol 2017; 23:1328-37.
• Martin VM, Virkud YV, Seay H, Hickey A, Ndahayo R, Rosow R, et al. Prospective Assessment of Pediatrician-Diagnosed Food Protein-Induced Allergic Proctocolitis by Gross or Occult Blood. J Allergy Clin Immunol Pract 2020;8:1692-9.e1.
• Buyuktiryaki B, Kulhas Celik I, Erdem SB, Capanoglu M, Civelek E, Guc BU, et al. Risk Factors Influencing Tolerance and Clinical Features of Food Protein-induced Allergic Proctocolitis. J Pediatr Gastroenterol Nutr 2020;70:574-9.
• Cetinkaya PG, Ocak M, Sahiner UM, Sekerel BE, Soyer O. Food protein-induced allergic proctocolitis may have distinct phenotypes. Ann Allergy Asthma Immunol 2021;126:75-82.
• Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test - European standards. Clin Transl Allergy 2013;3:3.
• Turjanmaa K, Darsow U, Niggemann B, RanceF, Vanto T, Werfel T. EAACI/GA2LEN position paper: present status of the atopy patch test. Allergy 2006;61:1377-84.
• Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome and allergic proctocolitis. Allergy Asthma Proc 2015; 36:172– 84.
• Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA, et al. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol 2014;134:382-9.
• Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. Immunol Allergy Clin North Am 2015;35:161-83.
• Arik Yilmaz E, Soyer O, Cavkaytar O, Karaatmaca B, Buyuktiryaki B, Sahiner UM, et al. Characteristics of children with food protein-induced enterocolitis and allergic proctocolitis. Allergy Asthma Proc 2017;38: 54-62.
• Sirin Kose S, Asilsoy S, Uzuner N, Karaman O, Anal O. Outcomes of Baked Milk and Egg Challenge in Cow’s Milk and Hen’s Egg Allergy: Can Tolerance Be Predicted with Allergen-Specific IgE and Prick-to-Prick Test?. Int Arch Allergy Immunol 2019;180:264-73.
• Guler N, Cokugras FC, Sapan N, Selimoglu A, Turktas I, Cokugras H et al. Diagnosis and management of cow’s milk protein allergy in Turkey: Region-specific recommendations by an expert-panel. Allergol Immunopathol (Madr) 2020;48:202-10.
• Ahmadipour S, Najafi M, Motamed F, Rahmani P. Feeding-based treatment of allergic proctocolitis and associated clinical outcomes. Clin Nutr ESPEN 2020;40:237-41.
• Caubet J, Cianferoni A, Groetch M, Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome. Clin Exp Allergy 2019:9:1178–90.
• Čelakovská J, Bukač J, Vaňková R, Krejsek I, Krcmova C. Andrýs. Egg allergy in atopic dermatitis patients-analysis of results of specific extract IgE and specific IgE to molecular components. Bird-egg syndrome, Food Agric Immunol 2021;32:265-82.
• Cetinkaya PG, Kahveci M, Karaatmaca B, Esenboga S, Sahiner UM, Sekerel B, et al. Predictors for late tolerance development in food protein-induced allergic proctocolitis. Allergy Asthma Proc 2020;41:11-8.